Background: The only available treatment of Celiac disease (CeD) is a strict, lifelong gluten-free diet (GFD). Although GFD leads to remarkable recovery in majority of patients with CeD, the perspective of symptoms response and when does symptom improve after initiation of GFD is still not well known. Hence, we interviewed patients with CeD about symptom recovery patterns in order to understand meaningful clinical improvement from their perspective.
Patients and Methods: A cross-sectional study was conducted at the Celiac Clinic and adult patients with biopsy confirmed CeD on GFD for 6 months to 2 years with self-reported good adherence were recruited. A semi-structured questionnaire was administered by a celiac expert dietician to capture symptoms at diagnosis, time to first noticeable improvement, magnitude of improvement, time to complete resolution, and persistent symptoms at time of interview.
Results: Among 44 patients, commonly reported symptoms were anemia (65.9%), diarrhea (50%), fatigue (47.7%), and abdominal pain (43.2%). Diarrhea and fatigue improved earliest — median 2 months (IQR 1–3) and 1.5 months (IQR 1–3) respectively-50% noticing improvement within first month. Abdominal pain and bloating improved at median of 3 months (IQR 1–5.25 and 0.75–3), with 71% and 82% improving within 3 months respectively. Patient-reported anemia improved gradually, median 3 months (IQR 3–6), with only 16% improving within the first month. Complete resolution occurred within 6 months for diarrhea, anemia, and abdominal pain; no patient with bloating or fatigue achieved complete resolution. Despite adherence, 56.8% reported persistent symptoms, most commonly fatigue (22.7%) and indigestion (13.6%).
Conclusion: Symptomatic recovery in GFD-adherent patients with CeD follows a distinct trajectory. While diarrhea improves within a median of 2 months, patient-reported anemia and fatigue may take up to 6 months. These findings support 3 months as a reasonable timepoint for initial clinical response assessment and 6 months for complete symptomatic resolution.